| Since 2001, the American Academy of Pediatrics have mandated that all health care providers who perform developmental surveillance to children ages 0 to 36 months use standardized developmental screening tools. Despite this mandate, national surveys have reported that only half of all family physicians and pediatricians ever utilize a formal developmental screening tool, with far fewer indicating regular use of them. Physicians note a number of personal and professional barriers that impact their ability to regularly implement developmental screening including time, knowledge of tools, and inadequate reimbursement. However, several developmental screening instruments are currently available that are quick, low cost, and have adequate sensitivity and specificity. Physicians who value using evidence-based medicine (EBM) practices with children remain up-to-date with the current best surveillance practices, which include the use of evidence-based screening tools. A sample of 131 South Dakota family physicians and pediatricians were surveyed regarding their developmental surveillance practices, barriers to implementing screening, and attitudes towards EBM. Frequent use of formal screening tools was indicated by 61.6% of physicians, with the Denver Developmental Screening Test (I or II) being the most commonly used tool (69.5%). Logistic regression analyses were used to determine how screening barriers, attitudes towards EBM, and training were related to whether or not a physician regularly used formal developmental screening tools. The first analysis revealed that two screening barriers, time limitations and inadequate reimbursement, significantly predicted frequecy of use of screening tools. Attitude toward EBM, however, did not predict frequency of use of screening tools when controlling for the impact of barriers. Physicians' choice of screening tool was also analysed. Screening tool training in medical school and residency significantly predicted whether or not a physician currently used a psychometrically sound instrument (e.g., Ages and Stages) or a non-psychometrically sound instrument (e.g., Denver I or II). Similar to the first analysis, however, attitude toward EBM did not significantly predict current screening tool use when controlling for screening tool training. |
